Provider Demographics
NPI:1841327111
Name:KAREN LEE LEYDE
Entity type:Organization
Organization Name:KAREN LEE LEYDE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEYDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-451-1100
Mailing Address - Street 1:6575 CAHILL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2065
Mailing Address - Country:US
Mailing Address - Phone:651-451-1100
Mailing Address - Fax:651-451-3939
Practice Address - Street 1:6575 CAHILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2065
Practice Address - Country:US
Practice Address - Phone:651-451-1100
Practice Address - Fax:651-451-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN493719800Medicaid
MN6C243EYOtherBLUE SHIELD OF MN
MN1289060001Medicare NSC